What are the clinical, quality-of-life, and cost consequences of 30 years of excellent vs. poor glycemic control in type 1 diabetes?

摘要: Abstract Objective The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy for type 1 diabetes delayed the development of microvascular neuropathic complications compared to conventional therapy. At end DCCT, all participants were trained in therapy, care was transferred community providers, difference HbA1c between treatment groups narrowed disappeared. Our objective describe outcomes quality-of-life costs associated with those who maintained excellent vs. poor glycemic control over 30 years. Research design methods We assessed incidence retinopathy, nephropathy, neuropathy, cardiovascular disease, acute metabolic complications, death, quality-of-life, tertile DCCT achieved a mean updated 8.8% (73 mmol/mol) Results Thirty years substantially reduced retinopathy requiring laser (5% 45%), end-stage renal disease (0% 5%), clinical neuropathy (15% 50%), myocardial infarction (3% stroke (0.4% 2%), death (6% 20%). It also resulted gain ~1.62 quality-adjusted life-years averted ~$90,900 per participant. Conclusions T1DM can reduce comorbidities, improve costs. These estimates represent benefits may be control.